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Acute heart failure therapy is largely unchanged
and includes nitrates, diuretics, and positive-pressure.
Even small elevations of blood pressure can drop cardiac output,
which triggers increasing systemic vascular resistance and eventually further decreases cardiac output.
There is no single diagnostic test for heart failure ;
it is a clinical diagnosis based on all clinical data, especially the history and physical examination.
S3 has the highest positive likelihood ratio for acute heart failure
Acute heart failure and hypertension :
Symptoms may be due to fluid redistribution more than fluid overload,
and treatment initially focuses on antihypertensive therapy.
Acute heart failure accompanied by hypotension or poor perfusion without another cause
may be an ischemic or structural heart trigger creating cardiogenic shock.
Such patients often benefit from inotropic agents
and invasive hemodynamic monitoring to guide other therapies.
High-output heart failure has a relatively normal ejection fraction
and is often caused by anemia or thyrotoxicosis.
Isolated right heart failure have lower extremity edema and jugular venous distension
but little or no pulmonary congestion;
the cause is usually from pulmonary disease,
valvular disease such as tricuspid regurgitation, or obstructive sleep apnea.
Noninvasive ventilation plus standard medical therapy reduces the need for intubation
and improves respiratory distress and metabolic disturbance versus standard therapy alone.
High-velocity nasal insufflation of oxygen
via nasal cannula (flow rates between 20 - 35 L/min)
may be superior to standard oxygen delivered by nasal cannula
and noninferior to noninvasive positive-pressure ventilation in treatment
of undifferentiated respiratory failure in adult patients presenting to the ED.
Hypertensive Acute heart failure
The failing heart is sensitive to increases in afterload,
with some patients developing pulmonary edema with a systolic blood pressure as low as 150 mmHg.
Nitroglycerin
A starting dose of 0.5 - 0.7 microgram/kg/min IV is common and titrated every few minutes
up to 200 micrograms/min based on the blood pressure tolerance and symptoms
After vasodilator therapy -> diuresis
Morphine is not a good choice for acute heart failure due to the potential for adverse events,
including the need for mechanical ventilation, prolonged hospitalization, intensive care unit admission, and mortality
β-Blockers are not usually initiated in the acute setting except to control rate-related heart failure.
Oral CCB have myocardial depressant activity and are not routine treatment for acute heart failure.
Avoid selective or nonselective NSAIDs in patients with acute heart failure.
They can cause sodium and water retention and blunt the effects of diuretics4 and may increase morbidity and mortality.
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